ASSOCIATION OF NUTRITIONAL STATUS WITH LUNG FUNCTION AND MORBIDITY IN CHILDREN AND ADOLESCENTS WITH CYSTIC FIBROSIS: A 36-MONTH COHORT STUDY

ABSTRACT Objective: To evaluate the association between nutritional status, lung function and morbidity in a 36-month cohort in children and adolescents with cystic fibrosis. Methods: Prospective cohort of children and adolescents with cystic fibrosis aged 1-15 years. At the baseline, the nutritional status was determined by weight-for-height and body mass index-for-age for children <2 years and ≥2 years, respectively, and classified as: nutritional failure, nutritional risk and acceptable; and by the 50th percentile, according to the World Health Organization (WHO) growth charts. Lung function was assessed by forced expiratory volume in one second (FEV1). Morbidity was determined by the presence of infection and hospitalization by pulmonary exacerbation. Risk ratio and 95% confidence interval (95%CI) were calculated, being significant when p<0.05. Results: We evaluated 38 children and adolescents (median age 3.8 years). Patients that were classified as having nutritional failure at baseline had a RR of 5.00 (95%CI 1.49; 16.76) to present impaired lung function after 36 months. Those classified bellow the 50th percentile had a RR of 4.61 (95%CI 0.89; 23.81) to present the same outcome. Nutritional status was not a risk factor for morbidity in this cohort. Conclusions: Nutritional deficit was associated with impaired lung function, but not with morbidity in children and adolescents with cystic fibrosis.

摘要
研究目的：评估囊性纤维化（cystic fibrosis）儿童及青少年36个月随访队列中营养状况、肺功能与发病率之间的关联。
研究方法：纳入1~15岁囊性纤维化儿童及青少年开展前瞻性队列研究。基线阶段，针对年龄<2岁的儿童采用身高别体重、≥2岁儿童采用年龄别体质指数评估营养状况，并参照世界卫生组织（World Health Organization, WHO）生长发育标准曲线，以第50百分位数为界，将营养状况分为营养衰竭、营养风险与营养良好三类。采用一秒用力呼气容积（forced expiratory volume in one second, FEV1）评估肺功能。发病率通过肺部急性加重相关感染及住院事件进行判定。计算风险比（risk ratio, RR）与95%置信区间（95% confidence interval, 95%CI），以p<0.05为差异具有统计学意义。
研究结果：本研究共纳入38例儿童及青少年患者，中位年龄为3.8岁。基线时被判定为营养衰竭的患者，在36个月随访后出现肺功能受损的风险比为5.00（95%CI 1.49; 16.76）。基线指标低于第50百分位数的患者，出现相同结局的风险比为4.61（95%CI 0.89; 23.81）。本队列中营养状况并非发病率的危险因素。
研究结论：囊性纤维化儿童及青少年的营养缺乏与肺功能受损存在关联，但与发病率无显著相关性。